310 Evaluation Of Nurse-Led Case Management Of Older Patients In General Practice

Joy Townsend
Aims To evaluate the effectiveness of nurse-led case management of older adults in primary care in improving patient quality of life, health status and satisfaction with practice care, and cost effectiveness in health service usage.
Methods Ten practices in Hertfordshire and London, serving 4423 older patients over 75 years, were randomly assigned either to intervention of nurse-led case management or to usual care, using a randomised controlled trial design. Following appropriate training, a GP, Practice and District Nurses and Social Service worker met regularly in intervention practices to agree care pathways and undertake regular review of care for 18 months, using 96 specially adapted evidence-based guidelines. Case management’s effectiveness was assessed in terms of mortality and morbidity rates, consultation rates, admissions to nursing homes, and number and length of hospital stays, collected from practice records and health authorities. Patient perceived quality of life and satisfaction with care was assessed by qualitative interviews and three questionnaires (baseline, mid-point, end-point), incorporating EQ5D and the Geriatric Depression Scale.
Results Self-perceived health state measured by EQ5D improved significantly for patients in the intervention practices, and nursing home admissions were lower for the intervention group in the follow-up period. Surgery attendance in the control group increased between baseline and follow-up significantly more than for the intervention group. Home visits increased significantly for intervention patients.
Nurse-led case management was associated with a positive impact on patient self-perceived health, affected the number and type of contacts with health care professional, and reduced the likelihood of nursing home admission.
310 Evaluation of Nurse-Led Case Management of Older Patients in General Practice